Laxative-Induced Contact Dermatitis

Abstract

A 5-year-old female with Charcot-Marie-Tooth neuropathy and a history of constipation presented to the emergency department with a new blistering buttocks rash, which was initially concerning for nonaccidental burn. Upon further investigation, it was found that Ex-Lax had been given to the patient for constipation. This had resulted in a bowel movement, which led to an irritant dermatitis. The patient was eventually diagnosed with senna-induced erosive diaper dermatitis. This case report highlights the importance of a thorough history and physical examination to prevent an unnecessary child abuse work-up.

Dermatitis versus nonaccidental trauma: A systematic review of initial pediatric misdiagnoses

“…2,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Among 26 patients initially investigated for NAT 17 (65.4%) burn, [10][11][12][13][14][15]17,19 4 (15.4%) physical abuse, 2,8,9,22 4 (15.4%) sexual abuse, 6,15,16,18 and 1 (3.8%) each for neglect, 17 T A B L E 1 List of nontraumatic dermatitis cases initially investigated for nonaccidental trauma. (Continues) strangulation, 18 and not specified 24 , the final diagnoses included irritant contact dermatitis (ICD; 14 [53.8%]), [11][12][13][14][15][16][17] phytophotodermatitis (8 [30.8%]), 8-10,22,24-27 allergic contact dermatitis (ACD; 2 [7.7%]), 2,6 perianal infectious dermatitis (1 [3.8%]), 18 and atopic dermatitis (AD; 1 [3.8%]). 19 Among the 14 ICD diagnoses, 9 (64.3%) resulted from laxative ingestion, 11-14,17 1 (7.1%) from tomato ingestion, 17 and 5 (35.7%) from infrequent diaper ch...…”

“…[15][16][17] Most ICD cases were first mistaken for nonaccidental burns (12/14; 85.7%). [11][12][13][14][15]17 Of the 26 cases initially investigated for NAT but later diagnosed as nonabusive dermatitis, 2,6,[8][9][10][11][12][13][14][15][16][17][18][19]22 7 (26.9%) reported CPS/authority involvement, 8,10,12,15,16,19,26 with one birthmark being incorrectly assessed as a bruise. 8 Among three patients initially diagnosed with nontraumatic dermatitis (AD, dermatitis artefacta, or eyelid dermatitis), 20,21,23 final diagnoses included physical…”

Ulcerated diaper dermatitis: Child abuse mimicker

“…As seen in patient 2, laxatives can predispose patients to flares of IDD. Notably, senna‐containing laxatives are associated with a burn‐like, blistering IDD that is significantly more likely with overnight diaper use 1,8–11 . The exact pathogenesis of this association is unclear, but senna may directly irritate the skin or further activate fecal enzymes 9 …”

“…Notably, senna-containing laxatives are associated with a burn-like, blistering IDD that is significantly more likely with overnight diaper use. 1,[8][9][10][11] The exact pathogenesis of this association is unclear, but senna may directly irritate the skin or further activate fecal enzymes. 9 Certain diets may also increase the risk of IDD.…”

“…1,[8][9][10][11] The exact pathogenesis of this association is unclear, but senna may directly irritate the skin or further activate fecal enzymes. 9 Certain diets may also increase the risk of IDD. For instance, cow's milk has been associated with IDD 7 due to high number of urease-producing bacteria, which further increase the pH of urine.…”